Rheumatoide Arthritis: Subtypen bei unbehandelten Patienten sagen Therapieerfolg voraus

2019 ◽  
Vol 44 (05) ◽  
pp. 301-302

Nicht alle Patienten mit rheumatoider Arthritis (RA) sprechen auf eine Therapie mit disease-modifying antirheumatic drugs (DMARDs) an. Obwohl verschiedene Subtypen der RA beschrieben sind, ist wenig über deren Vorhersagekraft bezüglich Klinik und Therapieansprechen bekannt. Eine aktuelle Studie zeigt, wie histopathologische und molekulare Subtypen bislang unbehandelter RA den Progress und das Therapieansprechen vorhersagen können.

2020 ◽  
Vol 45 (04) ◽  
pp. 274-276

Patienten mit einer Rheumatoiden Arthritis (RA) erleiden überproportional häufig kardiovaskuläre Komplikationen. Unter der Behandlung mit DMARDs (disease-modifying antirheumatic drugs) sinkt dieses Risiko. Wie gut die einzelnen konventionellen synthetischen DMARDs bzw. Biologika vor schweren Herzkreislaufereignissen und Schlaganfällen schützen, untersuchte nun ein Team von US-Forschern mithilfe einer Metaanalyse von Studiendaten.


2021 ◽  
Vol 46 (03) ◽  
pp. 236-236

Gemäß des Treat-to-Target-Konzepts empfiehlt das American College of Rheumatology für Patientinnen und Pa-tienten mit einer rheumatoiden Arthri-tis (RA), welche auf konventionelle syn-thetische DMARDs (disease-modifying antirheumatic drugs) nicht ausreichend ansprechen, die Umstellung auf bio-logische oder gezielte synthetische DMARDs. Die optimale Therapiereihen-folge ist allerdings unklar.


2017 ◽  
Vol 142 (24) ◽  
pp. 1844-1848
Author(s):  
Christoph Fiehn

Was ist neu? Die JAK-Inhibitoren Die Janus-Kinase (JAK)-Inhibitoren Tofacitinib und Baricitinib sind 2017 neu zur Behandlung der rheumatoiden Arthritis (RA), nach Versagen oder Unverträglichkeit von konventionellen krankheitsmodifizierenden Antirheumatika (disease modifying antirheumatic drugs; DMARD), zugelassen. Sie wirken intrazellulär durch Hemmung der JAK-Kinasen und verhindern so die Weiterleitung der aktivierenden Signale von Zytokinrezeptoren auf inflammatorische Zellpopulationen. Die JAK-Inhibitoren reduzieren effektiv die Krankheitsaktivität der RA, verbessern die körperliche Funktion und reduzieren die strukturellen Veränderungen der Gelenke. In Vergleichsstudien gegenüber dem TNF-alpha-Hemmstoff Adalimumab haben sie eine gleich gute, im Fall von Baricitinib sogar eine leicht überlegene Wirksamkeit gezeigt. Die Infektionsrate ist unter einer Therapie mit JAK-Inhibitoren im Vergleich zu konventionellen DMARD erhöht. Neuer Interleukin-6-Hemmstoff Das schon länger bewährte Wirkprinzip der Hemmung von Interleukin(IL)-6 wird nun durch den neuen Wirkstoff Sarilumab ergänzt. Die Substanz wirkt effektiv auf die Krankheitsaktivität, die körperliche Funktion und die radiologisch sichtbaren strukturellen Veränderungen der RA. Darüber hinaus reduziert sie die systemischen Symptome der Erkrankung.


2021 ◽  
Vol 46 (02) ◽  
pp. 121-122

Dank der modernen Pharmakotherapie erreichen viele Patienten mit einer rheumatoiden Arthritis (RA) eine anhaltende Remission. In diesem Fall können die Medikamente langsam ausgeschlichen werden. Ziel ist dabei die dauerhafte Beschwerdefreiheit ohne DMARDs (disease modifying antirheumatic drugs). In welcher Reihenfolge sollte das Tapering der verschiedenen Wirkstoffe optimalerweise erfolgen? Und wie häufig gelingt eine DMARD-freie Remission?


2009 ◽  
Vol 29 (04) ◽  
pp. 205-213
Author(s):  
M. Pierer ◽  
U. Wagner ◽  
C. Baerwald ◽  
O. Malysheva

ZusammenfassungRheumatische Erkrankungen sind schwere Erkrankungen, die mit anhaltenden Schmerzen einhergehen, zum Verlust an Lebensqualität, Funktion, Arbeitsfähigkeit und auch zur Verkürzung des Lebens führen können. Sie verursachen erhebliche Kosten für das Gesundheitssystem. Mehrere Biologika als neue „disease modifying antirheumatic drugs“ sind in die Therapie von rheumatoider Arthritis, Spondyloarthropathien, Psoriasis-Arthritis und idiopathischer juveniler Arthritis eingeführt worden. Es fand sich eine zum Teil große Effektivität der Biologika, wobei dieser Artikel sich auf die Anti-TNF-Therapien, nämlich Adalimumab, Etanercept und Infliximab, konzentriert. Weitere Anti-TNF Therapien sind in Entwicklung. Mit deren Zulassung ist in den nächsten Monaten zu rechnen.


2020 ◽  
pp. 33-38
Author(s):  
E. Yu. Gan ◽  
L. P. Evstigneeva

Purpose of the study. Assessing the association between the life quality of patients with Sjogren’s Disease and ongoing therapy with various disease-modifying antirheumatic drugs.Material and methods. The study was conducted on the basis of the regional rheumatology center of the consultative diagnostic clinic of the Sverdlovsk Regional Clinical Hospital No. 1. This work is based on the results of a simultaneous study of 74 patients with primary Sjogren’s Disease (SD), distributed in three comparison groups receiving various disease-modifying antirheumatic drugs chlorambucil, methotrexate and hydroxychloroquine. The diagnosis of SD was carried out according to European-American criteria AECGC (2002) [18]. In order to analyze the quality of life of patients with SD, the 36-Item Short Form Health Survey (SF‑36) was used. Statistical data processing was carried out using Statistica 7.0 program.Results. Assessment of the quality of life of patients with SD, which is an integrative criterion of human health and well-being, revealed the absence of statistically significant differences (p > 0.05) on eight scales and two health components of the SF‑36 questionnaire in the analyzed groups that differ in the treatment of disease-modifying antirheumatic drugs chlorambucil, methotrexate and hydroxychloroquine.Conclusions. The obtained data indicate an equivalent quality of life in SD patients treated with different disease-modifying antirheumatic drugs methotrexate, chlorambucil and hydroxychloroquine, and therefore hydroxychloroquine can be considered as an alternative basic therapy in patients with SD with certain limitations and contraindications methotrexate and chlorambucil.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 862.2-863
Author(s):  
M. K. Chung ◽  
J. S. Park ◽  
H. S. Lim ◽  
C. H. Lee ◽  
J. Lee

Background:Rheumatoid arthritis (RA) predominantly affects women and has a significant impact on childbearing. Several population-based studies identifying incidence, prevalence, and medication use of RA have been reported, yet epidemiological studies focusing on women with RA in childbearing years are missing.Objectives:We aimed to identify the incidence, prevalence and medication use of RA among Korean women in childbearing years.Methods:From National Health Insurance Service (NHIS) data (2009-2016), containing inpatient and outpatient claim information for approximately 97% of the Korean population, we identified 9,217,139 women aged between 20-44 years. Incidence and prevalence of RA in the specific sociodemographic group of women in childbearing age were analyzed, and the prevalence of medication prescription were compared between women with RA and controls without rheumatic diseases such as RA, systemic lupus erythematosus, and ankylosing spondylitis. Individuals with RA were defined by the presence of International Classification of Disease, 10th revision code, M05. The medication use was defined as receiving > 90days prescriptions of NSAIDs, corticosteroids (CSs), and conventional synthetic (cs) disease modifying antirheumatic drugs (DMARDs) or > 1day prescription of biologic (b) DMARDs.Results:Total 24,590 women with RA were identified. The average incidence of RA during 2011-2016 among women in childbearing years was 24.1/100,000 person-years (PYs) (95% CI 20.91-27.31) with a yearly increase from 20.99/100,000 PYs in 2011 to 28.38/100,000 PYs in 2016. The average prevalence of RA during 2009-2016 among women in childbearing years was 105.2/100,000 PYs (95% CI 99.0-111.5) with a minimum of 95.7/100,000 PYs in 2009 and a maximum of 110.5/100,000 PYs in 2016. There were increasing trends in both incidence and prevalence of RA according to age among women in childbearing years peaking in the age group of 40-44 years. The prescriptions of NSAIDs, CSs, csDMARDs and bDMARDs were more frequent in women with RA than controls (NSAIDs; 94.21% vs 21.79%, CSs; 83.65% vs 4.28%, csDMARDs; 91.23% vs 0.41%, bDMARDs; 0.11% vs 0%, p<0.001).Conclusion:The incidence and prevalence of RA are high among Korean women in childbearing years, and medication use was significantly more frequent in this specific population than controls. High disease burden is imposed upon women in childbearing years.References:[1] Won S, Cho SK, Kim D, Han M, Lee J, Jang EJ, Sung YK, Bae SC: Update on the prevalence and incidence of rheumatoid arthritis in Korea and an analysis of medical care and drug utilization. Rheumatol Int 2018, 38(4):649-656.[2] Smeele HTW, Dolhain R: Current perspectives on fertility, pregnancy and childbirth in patients with Rheumatoid Arthritis. Seminars in arthritis and rheumatism 2019, 49(3s):S32-s35.Table 1.Medication use among women with RA and controls in childbearing age between 20-44 years during 2009-2016Control(n=155,486)RA(n=23,756)n(%)n(%)PNSAIDs33,887(21.79)22,380(94.21)<.0001Steroids6,653(4.28)19,871(83.65)<.0001csDMARDs634(0.41)21,673(91.23)<.0001bDMARDs0(0.00)27(0.11)<.0001RA, rheumatoid arthritis; NSAID, non-steroidal anti-inflammatory drug; cs, conventional synthetic; b, biologic; DMARDs, disease modifying antirheumatic drugsDisclosure of Interests:None declared


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1437.1-1438
Author(s):  
A. Fazaa ◽  
H. Boussaa ◽  
S. Miladi ◽  
K. Ouenniche ◽  
L. Souabni ◽  
...  

Background:In the recent decades, biological disease-modifying antirheumatic drugs (bDMARDs) have significantly improved management and quality of life in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA).However, bDMARDs have also a strong influence on the immune system, leading to a risk of serious infection. Reactivation of hepatitis B (HBV) and C (HCV) virus is one of the most redoubtable complications of these immunosuppressive agents.Objectives:The aims of this study were to determine the screening rate for hepatitis B and C before starting a biological treatment and to examine the prevalence of their markers in patients with RA or SpA.Methods:Our study evaluated all patients included in the Tunisian registry BINAR (Biologic National Registry) since 2018 who had RA (ACR/EULAR 2010) or SpA (ASAS criteria) aged with more than eighteen years old and receiving their first bDMARDs during the two past years.The following information were retrieved from the registry: demographic data on the patients, disease parameters, medication, HBV surface antigen (HBs Ag), antibody to HBs Ag (Anti HBs), antibody to HBV core antigen (Anti HBc), HBV-DNA, antibody to HCV (anti HCV) status and liver function tests (AST: aspartate aminotransferase; ALT:alanine aminotransferase).Results:A total of 298 patients was included, 111 men and 178 women, with a mean age of 49.2 ± 14.1 years old [18-79]. Among them, 58.7% were diagnosed with RA and 41.3% were diagnosed with SpA. The mean disease duration was 6.7±3.5 years [1-12] in patients with RA and 6.5±3 [1-12] in patients with SpA. The mean Disease Activity Score (DAS28) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were respectively of 4.9±1.5 [1-8] and 4.1±1.8 [0-9].Therapeutically, 167 patients (56%) were on Prednisone at a mean daily posology of 8.2±5.4 mg [4-60] and 70.3% on conventional synthetic disease modifying antirheumatic drug (csDMARD) in association with bDMARDs. It was about Tumor Necrosis Factor alpha antibodies (anti TNF a) in 87.9% of cases, Tocilizumab in 10.4% of cases and Rituximab in 5% of cases.A screening of HBV was performed in 286 patients (96%). Ag HBs was positive in two cases (0.7%), and anti-HBc was positive in 16 cases (6.4%) which indicate a prior HBV infection. Fifteen patients (6%) were immunized with positive anti HBs. HBV-DNA was measured in 177 cases (66.8%) and was positive in 15 patients (6%).HCV infection was searched in 282 patients (94.6%) and anti-HCV was negative in all cases.AST and ALT mean rates were respectively of 18.3 [2-108] and 17.9 UI/l [2-74]. A perturbation of these liver function tests was observed in 13 patients (4.4%).Conclusion:Screening for hepatitis B and C were performed respectively in 96% and 94% of our Tunisian patients before receiving any bDMARDs. This should be systematic to avoid HBV reactivation which can lead to fulminant hepatic failure with a severe prognosis.Disclosure of Interests:None declared


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